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Sheryl Ryan, MD; Anne Riley, RN, PhD; Myungsa Kang, MS; Barbara Starfield, MD, MPH

Arch Pediatr Adolesc Med. 2001;155:184-190.

Objective  To examine those factors associated with the use of different types of ambulatory health services in a rural adolescent population.

Methods  The student bodies of 2 middle schools and 2 high schools in rural areas in a mid Atlantic state (N = 1615) were surveyed using a self-administered health status and health services use instrument. Logistic regression was used to assess factors predicting receipt of (1) preventive services, (2) problem-focused services, and (3) emergency services.

Results  One third of the rural youth reported having received preventive services within the previous 3 months; 41% received problem-focused care, and 18% received emergency services. Having the same provider for both preventive and illness care was the most consistent and significant predictor of receipt for all types of ambulatory services. Of special note is the greater use of emergency services when subjects did not have a consistent provider for both preventive and illness care. Health need variables, measured across a wide range of domains, were additionally predictive, and their significance varied according to the type of services received.

Conclusions  This study provides compelling evidence that for rural adolescents, having a regular source of care and medical need are the most important predictors of use across a variety of types of ambulatory care.

From the Division of Adolescent Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY (Dr Ryan); and the Department of Health Policy and Management, Johns Hopkins School of Hygiene and Public Health, Baltimore, Md (Drs Riley and Starfield and Ms Kang).

Corresponding author and reprints: Sheryl Ryan, MD, Department of Pediatrics, Rochester General Hospital, 1425 Portland Ave, Rochester, NY 14621 (e-mail: sheryl.ryan{at}viahealth.org).

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